Provider Service Specialist - Golden Valley, MN

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.OptumHealth Care Solutions offers tailored programs that can enhance clinical outcomes and reduce costs for customers. The Care Solutions organization offers best-in-class programs and care management services to help consumers receive the right care at the right time in the right place.   Position Description: Accountable for the full range of provider relations and service interactions within Physical Health's network of providers including non-PAR providers that have relevant service issues. The Provider Service Specialist identifies root causes and resolves escalated provider issues (Level II and Level III types of cases ) that have not and cannot be resolved through standard provider services pathways due to their complexity.  These are non-standard issues with higher visibility. Take accountability for resolving complex provider issues, train and education of providers to improve provider satisfaction,  support the national network expansion and contracting, prevent legal escalation of issues, and serve as the foundation for making ongoing improvements to provider contracts and setup.  The Provider Service Specialists serve the entire United States and manage providers that serve commercial and public sector clients and membership, internal to UHG and external health plans.   Primary Responsibilities:. Establish and maintain strong working relationships with PAR providers needing a higher level of  management by employing a wide variety of communication tools including the phone, emails, faxes and letters. Serve as the provider's subject matter expert and "go to" person for escalated problems and service issues.  Specialists serve in this capacity for Physical Health when interacting with other UHG business service departments. Autonomously take the initiative to engage relevant departments across UHG to investigate and uncover root causes for the provider issues which can range from one or two root causes that are fixable to multi layered causes requiring the initiation of long term projects. Use a wide range of databases and people  to assess claims dollars,volume, network setup, contract status, client expectations to establish resolution strategies.  The scope of contacts and resources include but is not limited to  MSAs, PCSU, CPM, MPS, ARO, ACG and Network Operations teams within Physical Health and UHG. Engage the correct teams and resources to develop a project plan, design a solution and timeline for the resolution and implement the strategy that satisfies the provider and internal and external stakeholders. Drive the project to completion hitting the timelines established and keeping the key parties updated via various communication methods during the working phase and after the project is completed. Educate providers and inter-department teams on Physical Health Programs and processes.  Represent provider services in inter-departmental process improvement teams and consult on business changes needed to eliminate or reduce provider service issues. Qualifications: Excellent Communication skills: Speak clearly and concisely Ability to take verbal queues and give them to demonstrate active listening over the phone Writing skills that demstrate mastery of the english language and summation of complex topics Strong Phone skills: Demonstration of helpful tone, "smiling" service, conference calling, logging calls Project Management skills: Take the initiative on a project Use of project management tools Documentation Hit deadlines Update stakeholders Drive to completion Strong computer skills: Can easily navigate Word, Excel, PowerPoint Take initiative to learn new databases and tools to extract value from those databases Experience handling complex issues in a matrix environment over the phone. Demonstrate autonomy and good judgement using strong examples from past work experience. Experience using a wide range of people and resources to investigate issues and identify problems. Understanding of provider contracting, networks, fee schedules, claims process.?????Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V   UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.